Identifying Dental Instruments and Preparing Dental Trays Unit 18.7 Dr. Hale

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Identifying Dental Instrumentsand Preparing
Dental TraysUnit 18.7Dr. Hale

• Medical Technologies
• Jr. Program

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Methods for Setting Up Dental Trays

• 1. Correct preparation for assisting with dental
  procedures includes setting up trays of
  instruments and supplies
• 2. Various methods are used to set up trays for
  specific dental procedures
• 3. Instruments and supplies used are determined
  by the procedure that will be performed and the
  personal preference of the dentist.

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• 4. In some areas, trays are set up immediately
  before use
• a. Assistant prepares room cleans, applies
  barriers, and so forth
• b. Seats and drapes patient
• c. Sets up tray with supplies and sterilized
  instruments

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• 5. In other areas, preset trays are used
• a. Contents of trays are determined by dentist
• b. Trays are set up for oral examinations,
  amalgam, composite, surgical extractions, and
  other similar procedures
• 1) Oral examination patients teeth cleaned
  and examined, dental radiographs or X-rays
  may be taken
• 2) Amalgam and composite

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• aa. Two main restorative materials used to
  repair carious lesions or tooth decay
• bb. Doctor removes damaged tooth structure and
  creates an opening called a cavity preparation
• cc. Amalgam, silver restorative material, or
  composite, an esthetic restorative material, is
  placed in the cavity preparation

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Cavity Preparation
Radiographs and pictures of lower first
Molar showing three canal orifices Mesia
l-Buccal and Mesial-Lingual canals
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Lesion before cavity preparation
Cavity prep showing dentin
Completed restoration
Amalgam Condensers
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• 3) Surgical extraction removal of a damaged tooth

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• c. Patient is seated and draped
• d. Sterilized procedure tray is obtained and
  placed in room
• e. If additional instruments or supplies are
  needed, they can be added to the prepared tray

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• 6. Color coded trays
• a. Instruments are color coded with tiny bands
  to denote use for specific procedures
• b. Examples red for amalgam, blue for
  composite, and so forth
• c. Full set of color coded instruments placed
  on tray
• d. Sterilized as one unit

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Examples of Color-Coded Trays
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Organization of Trays

• 1. Items on trays should be organized and in
  proper sequence
• 2. Usually arranged in order of use
• 3. After instrument is used, returned to same
  place on tray in case it is needed again
• 4. Easier for assistant to locate instruments and
  increases overall efficiency

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Main Parts of a Dental Hand Instrument

• 1. Blade, nib, or point
• a. Blade is cutting portion of an instrument
• b. Nib is the blunt, serrated, or smooth working
  end of a condensing instrument
• c. Point is the sharp end used to explore and
  detect
• 2. Shank portion that connects shaft or handle
  to the blade, nib, or point
• 3. Shaft handle of the instrument, usually
  hexagonal to provide a better grip

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Standard Instruments

• 1. Mouth mirror
• a. Used to view areas of oral cavity, reflect
  light on dark surfaces, and retract lips, and
  so forth for better visibility
• b. Used in every basic tray set up
• c. Available in various sizes and with plain or
  magnifying ends

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• 2. Explorer
• a. Used to examine the teeth, detect carious
  lesions, and note other oral conditions
• b. Available in many shapes and sizes
• c. May be single or double ended

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• 3. Cotton pliers
• a. Used to carry objects such as cotton pellets
  or rolls to and from the mouth
• b. Some lock, some do not lock
• c. Also called operating pliers or college
  pliers

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Examples of Cotton Pliers
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Cotton Pliers
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• 4. Scalers
• a. Used to remove calculus (tartar) and debris
  from the teeth and sub-gingival pockets
• b. Available in many shapes
• c. Used mainly for prophylactic (cleaning) or
  periodontal (gingiva) treatments

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• 5. Periodontal probes
• a. Used to measure the depth of the gingival
  sulcus (space between the tooth and free
  gingiva)
• b. Has round, tapered blade with a blunt tip
  marked in millimeters (mm)

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Periodontal probe
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• 6. Excavators
• a. Group of instruments used mainly for removal
  of caries and refinement of internal opening in
  a cavity preparation
• b. Spoons
• 1) Used to remove soft decay from cavity
• 2) Cutting instruments with small curve or
  scoop at the working end

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• c. Hoes
• 1) Used primarily on anterior teeth to remove
  caries and to form line angles
• 2) Have one or more angles to shaft, with last
  length forming the blade
• 3) Also used in scraping, planning, and direct
  thrust cutting motions

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Dental Hoes
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• d. Hatchets
• 1) Used to refine internal line angles
• 2) Used to smooth and shape a cavity
  preparation
• 3) Used to remove hard-type caries

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Dental Hatchets
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• 7. Chisels
• a. Used for cutting and shaping enamel
• b. Enamel hatchet
• 1) Similar to other hatchets but blade is
  larger and heavier
• 2) Blade is beveled on only one side

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• c. Gingival margin trimmer
• 1) Special chisel for placing bevels on
  gingival enamel margins of proximoocclusal
  cavity preparations
• 2) Chisel blade is placed at an angle to the
  shaft, not straight across like a hatched
• 3) In addition, the blade is curved, not flat
  like a hatchet

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Examples of Gingival Margin Trimmers
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Gingival Margin Trimmers
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• 8. Cleoid-discoid carver
• a. Double ended instrument
• b. Also available as cleoid or discoid single
  ended
• c. Discoid is disc shaped, with cutting edge
  around the blade
• d. Discoid is disc shaped, with cutting edge
  around the blade

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Hollenbach Carver
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• 9. Plastic filling instruments (PFIs)
• a. Double ended instrument with packing end and
  cutting end
• b. Used to shape and condense a restorative
  material while it is still malleable or capable
  of being shaped or formed
• c. Also used with cements before setting occurs
• d. Most have a small condenser at one end and a
  paddle like blade at the other end

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• 10.Amalgam instruments
• a. Used mainly with amalgam restorations
• b. Amalgam carrier
• 1) Used to carry small masses of freshly
  mixed amalgam to the cavity preparation
• 2) Available as lever type or plunger type
  carrier

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Amalgam Carriers
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• c. Amalgam carver
• 1) Used to carve or shape freshly placed
  amalgam t restore tooth to natural anatomy
• 2) One example is Hollenback carver
• d. Condenser plugger
• 1) Used for condensing and packing amalgam into
  prepared cavity
• 2) Ends may be serrated or plain

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Condenser Pluggers
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• e. Matrix retainer and band
• 1) Retainer is used to hold band in place
• 2) Matrix band is short strip of steel or other
  metal not affected by mercury
• 3) Used to form a wall around a cavity so
  amalgam can be packed into place
• 4) Plastic matrix strips are used with
  composite restorative material

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Matrix Retainer Band Placement
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• 11.Burnishers
• a. Contain working points in shape of balls or
  beaver tails
• b. Used primarily to burnish (adapt) the
  margins of gold restorations to a better fit
• c. Also used to polish other metals

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Burnishers
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• 12.Plastic composite instruments
• a. Set of plastic instruments used with
  composite
• b. Metal instruments can discolor composite
• 13.Surgical instruments
• a. Very numerous depending on type of oral
  surgery performed
• b. Main instruments used in surgical extractions

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• c. Other specific instruments and supplies such
  as chisels, hemostats, needle holders, and suture
  materials might also be used
• d. Surgical forceps
• 1) Also called extracting forceps
• 2) Used to extract or remove teeth
• 3) Different ones each for specific tooth to be
  extracted

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Surgical Forceps
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• e. Periosteal elevators
• 1) Used for lifting the mucous membrane and
  tissue covering the bone
• 2) Double ended instrument with a blade at each
  end
• f. Root elevators
• 1) Various types, shapes, and sizes
• 2) Used to loosen tooth out of its socket

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Periosteal Elavators
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Root Elevators
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• g. Root tip picks
• 1) Straight or contra-angled
• 2) Used to remove small tips from a socket such
  as a root tip or piece of bone
• h. Rongeur forceps
• 1) Used to trim or cut bone tissue
• 2) Tips of forceps may be round or square
• 3) Tough sharp blade extends around both sides
  and end of the tips

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Rongeur Forceps
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• i. Lancet
• 1) Similar to scalpel and blade
• 2) Used to lance and incise or cut tissue
• j. Bone/surgical chisels
• 1) Used for cutting bone structure in oral
  cavity
• 2) Some used by hand, others require use of
  surgical mallet

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Types ofBone Chisels
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Guidelines for Preparing Surgical Trays

• 1. Use only items that are usually needed
• 2. Placing instruments and supplies that are
  needed occasionally on the tray can decrease
  efficiency and crowd the items
• 3. Certain items usually stored in assistants
  cart
• a. Drape and clips
• b. Dental bases, cements, and restorative
  materials

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• c. Extra cotton products or dressings
• d. Instruments used for specific problems or
  procedures

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Examples of Tray Set-Ups

• 1. Prophylactic or general examination tray
• a. Used for basic examination and cleaning of
  teeth
• b. Supplies and instruments on tray include
• 1) Mouth mirror, explorer, pliers
• 2) Scalers
• 3) Periodontal probe for an adult
• 4) Prophylactic cups, paste, and brushes
• 5) Fluoride treatment supplies

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• 2. Amalgam restoration tray
• a. Used for amalgam restoration
• b. Include basic instruments and supplies
• c. Add amalgam carriers, condenser pluggers,
  carvers

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• 3. Composite or esthetic restoration tray
• a. Used for placement of composite or esthetic
  restoration
• b. Include basic instruments and supplies
• c. Add plastic composite instruments, fine brush

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• 4. Surgical extraction tray
• a. Used to remove or extract teeth
• b. Include basic instruments and supplies
• c. Instruments added vary depending on type of
  extraction
• d. Usually add extracting forceps, root-tip
  elevators, root-tip picks, periosteal elevators,
  Rongeur forceps, lancets, bone chisel, and a
  needle holder with suture materials

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Surgical Extraction Tray
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Basic Principlesfor Preparing Dental Trays

• 1. Lay out general patient equipment such as
  records, X-rays, patient drape and clips
• 2. Prepare handpieces for use
• a. Make sure all in good working order
• b. Add sterile tips, barriers, and so forth
• 3. Place basic instruments and supplies on tray

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• 4. Add specific instruments for procedure being
  done
• a. Put instruments in order of use
• b. Leads to increased efficiency and
  organization
• 5. Prepare dental cements and bases, mixing pads,
  and mixing instruments

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• 6. Add additional equipment that might be used
  such as prophy paste, fluoride trays, matrix
  bands, wooden wedges, finishing strips,
  articulation paper, etc
• 7. Add supplies for rubber dam (device used to
  keep oral cavity dry), anesthesia supplies, and
  special items to tray

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• 8. Review procedure and check tray to be sure all
  items present
• 9. Remember that equipment, supplies, and
  instruments used will vary from doctor to doctor
  follow your doctors preferences

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